Health Attestation & Code of Conduct
This form must be completed no later than 14 days prior to the event start for each competition you are attending. Further, you must submit a new form for each competition you are attending.
Fort Wayne, Ind.
If you do not have a member number, you must create a non-member account. Click here for instructions
U.S. Figure Skating Member Number
Must complete and pay for Henderson chaperone application, click HERE
Must complete and pay for Spokane chaperone application, click HERE
Must complete and pay for Norwood chaperone application, click HERE
Must complete and pay for Alpharetta chaperone application, click HERE
Must complete and pay for Leesburg chaperone application, click HERE
Must complete and pay for Blaine chaperone application, click HERE
Must complete and pay for Fort Wayne chaperone application, click HERE
Must complete and pay for Frisco chaperone application, click HERE
Traveling From (City, State)
Chaperone(s) First & Last Name - Limit up to TWO immediate family members with access to arena ONE per athlete at a time
Associated Athlete First & Last Name
At all times during the competition, I pledge to:
Accurately report all signs and symptoms of illness upon registration
Accurately report all signs and symptoms of illness to medical personnel
Adhere to all risk reductions strategies, which may include:
Bring multiple to ensure changing due to soiling and/or loss
Must always be worn over mouth and nose during when inside and/or off-ice
Paper bag to contain bag when not utilized during performance and avoid cross-contamination, labeled with athlete’s name
Hydration container (labeled)
Tissues and receptacle for soiled products (labeled)
Hand Sanitizer/Soap product (labeled)
Avoid touching my face and cover my cough and/or sneeze with elbow
Avoid greeting other with handshakes, hugs, and high-fives
Wash my hands with soap and water for 20 sec/or wash with hand sanitizer with (minimum 60% alcohol) if I touch my face, eyes, nose, mouth, eat, or use the restroom
Abide by all area sanitation protocols at all times
Abide by all social distancing policies and procedures at all times
Upon checking into the arena, I will answer the health screening questions truthfully
If an answer yes to having any symptoms, I will be subject to a medical evaluation and need medical clearance
Agree to having my temperature taken upon entering the arena and should I have over 100.4, I will be required to seek medical clearance
If I am diagnosed with Covid within 14 days of the event, I agree to being withdrawn from the event.
I have answered all questions truthfully and will follow U.S. Figure Skating's Code of Conduct.
Reminder, you must complete this attestation form for each competition you are attending.